Veterans who have mesothelioma have several options for treatment. If you visit one of the mesothelioma-specific treatment centers in the U.S., you will have access to mesothelioma specialists who have experience treating many veterans with the disease. Many centers are also involved in clinical trials that offer more options for treatment.
Because mesothelioma is so rare, it is difficult to gather funding and research participants to evaluate new treatments. As of yet, there is no definitive cure for mesothelioma. However, new treatments are being developed all the time to help mesothelioma patients live longer and more comfortably with the disease.
Basic Types of Treatment
The types of treatment available for mesothelioma are similar to those of other kinds of cancer. Doctors typically use a combination of surgery, chemotherapy and directed radiation therapy to shrink the cancer and to decrease the number of cancer cells in the body. The treatment you receive depends on your mesothelioma cell type, the stage of the cancer and your overall health at the time of diagnosis.
These are 3 common types of mesothelioma treatments.
Surgery is performed to remove all traces of cancer in the pleura or peritoneum. It can also be done to remove only those parts of the cancer that are causing the most problems.
Common surgeries performed on mesothelioma patients include:
- Extrapleural Pneumonectomy (EPP)
- Pleurectomy with Decortication (P/D)
- Cytoreduction with HIPEC
If the mesothelioma has metastasized, or spread, only about one in five patients will receive surgery. This is because doing the surgery may not have much of an impact, but may reduce the quality of life for the patient.
The chemotherapy used depends on the mesothelioma cell type and on the results of clinical studies performed.
Several regimens for chemotherapy in pleural mesothelioma include:
- Pemetrexed with cisplatin
- Pemetrexed with carboplatin
- Ralitrexed with cisplatin
In pleural chemotherapy, the medications can be injected into the vein or applied into the pleural cavity to act locally on the cancer cells.
As in pleural chemotherapy, peritoneal chemotherapy can be injected into a vein, where the chemotherapy travels throughout the body. It can also be given by putting the chemotherapy into the peritoneal space in the abdomen. This is what is done in the cytoreduction with HIPEC procedure.
Common chemotherapy agents used in peritoneal mesothelioma include:
- Pemetrexed and cisplatin
The doctor may start just one drug to see how you handle it, and then add more if you tolerate the first one and still have cancer to reduce. If one treatment type fails, you may receive a course of a second type of chemotherapy, which may work better.
Sometimes a combination of three drugs — irinotecan, cisplatin and mitomycin — are used together as a second round of chemotherapy.
Radiation therapy can prolong the life of mesothelioma patients. It involves giving X-ray radiation in high doses so that cancer cells are killed. A new choice for radiation therapy is called intensity-modulated radiotherapy (IMRT), which is effective because it avoids healthy tissue and targets only cancer cells.
This is done by some doctors but not by others so it pays to see if your mesothelioma specialist does this kind of therapy when you first meet them.
Many mesothelioma specialists take part in clinical trials that are designed to find better treatments and better ways to diagnose mesothelioma. There are at least fifty clinical trials going on at any given time. By participating in a clinical trial, you may get access to a better treatment for mesothelioma that hasn’t hit the market yet.
You will also be helping future generations of mesothelioma patients, who will benefit from what is learned by doing clinical trials. Some clinical trials are looking at different ways to diagnose mesothelioma, while others are looking at new treatments; these may include different chemotherapy agents, immunotherapy, gene therapy or phototherapy, which uses drugs that bind to cancer cells and are activated by exposure to high-intensity lights.
If the disease is not considered curable, doctors may shift the focus of treatment from curing the disease to keeping you comfortable with the disease for as long as you live. Often, you join a hospice program. In hospice, there are specialists that understand things like pain management, alternative therapies, and end of life care.
You may stay at home and still be in a hospice program or you may be in a hospital or a specialized center for hospice care. In hospice, you will be given medications to relieve shortness of breath, pain, and other symptoms.
Emotional and spiritual support is often part of hospice care. You are generally admitted to hospice when it is expected that you have fewer than six months left to live.
Some kinds of treatments are designed to help you feel better and to limit the side effects of regular cancer therapies. These types of therapies include acupuncture therapy, massage therapy, meditation, and other therapies derived from East Asian medicine. Alternative treatments tend to reduce the stress of having mesothelioma and to help you feel less anxious about having the disease.